AMERICA'S NEXT TOP MODEL
Please read the preceding Eligibility Requirements before completing this application. The Eligibility Requirements contain important instructions regarding the videotape, photographs and other items, which must accompany any submitted participant application, as well as submission guidelines for your application package. And remember, above all else, you must BE HONEST! Any answer may be verified for accuracy. Don't answer a question hoping to give us the answer we "want" to hear.
Section I: The Basics
Have you ever formally or otherwise changed your name or used an alias or another name? If so, what other names and/or aliases have you used?
Height and Weight (PLEASE NOTE: You must be at least five feet and seven inches [5'7"] in height to be eligible. However, the Producers are looking for a variety of models, including plus size models.)
Social Security Number
Driver's License Number
Are you a United States citizen? Yes/No
Do you have a current United States passport (PLEASE NOTE: Participants on the show may be required to travel internationally)? Yes/No
If yes, expiration date:
Home Street Address
Cellular (If any)
Pager (If any)
E-mail Address (If you don't have one, tell us why you don't.)
Name, Phone Number, and Address of Closest Friend
Name, Phone Number, and Address of Nearest Relative
Name and Phone Number of an Emergency Contact and relationship to you
Do you have a homepage on the Internet? If so, what is the address?
Age (as of today)
PLEASE NOTE: Applicants must be between the ages of 18 and 27 at the time of this application
Date of Birth (Month/Day/Year)
Marital Status (Circle one of (a) through (g) and answer each of the accompanying questions as applicable)
How many times?
(d) NOT MARRIED, BUT LIVE W/SIGNIFICANT OTHER
How many times?
If you are married or in a relationship, how would you rate your relationship on a scale of 1-10? Please explain.
If you are married or in a relationship, how will your partner feel about the potential two-month separation?
What is the highest level of education you've completed? (Circle one)
(a) NO SCHOOLING
(b) HIGH SCHOOL
(c) ASSOCIATE COLLEGE DEGREE
(d) BACHELOR'S COLLEGE DEGREE
(e) MASTER'S COLLEGE DEGREE
(f) PROFESSIONAL OR DOCTORAL DEGREE
What school(s) did you attend? (Include the city and state)
Are you a member of any professional performing arts unions (e.g. AFTRA, SAG, Equity or ACTRA)? If so, which one(s)?
Do you have any acting, singing or performing aspirations? If so, tell us your wishes and goals.
Have you ever appeared on television? If so, in what capacity did you appear and when? Did you appear on national television?
Have you ever appeared in any magazines? If so, which magazine and in which issue?
Do you have any experience as a model OF ANY KIND? If so, please explain, including when and for what. PLEASE NOTE: You are not eligible if you have modeled in a national campaign within the last five (5) years.
Have you ever had a modeling contract? If so, please list the name and address of the entity with which you had such modeling contract.
Do you currently have a modeling contract? If so, please list the name and address of the entity with which you currently have such modeling contract.
Have you ever been represented by a manager or agent? If so, please specify what the representation covered (e.g., modeling or acting).
Are you currently represented by an agent or manager? If so, please specify what the representation covers (e.g., modeling or acting). PLEASE NOTE: If you are currently represented by an agent or manager and are selected to be interviewed, you must furnish sufficient evidence to the Producers that you are able to terminate such representation in the event that you are selected to participate in the show. If selected to participate in the show, you must terminate, prior to your participation, any representation which conflicts with the terms of your participation.
Have you ever been arrested? If so, tell us about it (include dates, city & state).
Have you ever been charged with a crime? If so, tell us about it (include dates, city & state).
Have you ever been convicted of a crime? If so, tell us about it (include dates, city & state).
Have you ever had a restraining order issued against you? If so, tell us about it (include dates, city & state).
Have you ever had a restraining order issued against someone else? If so, tell us about it (include dates, city & state).
Are you involved in any pending litigation? If so, tell us about it (include dates).
Section II: Family & Lifestyle
Do you have any children? If so, please list their name(s) and age(s).
Regardless of your marital status, describe your ideal romantic partner.
Describe your relationship with your mother.
Describe your relationship with your father.
What is your current occupation?
Are you a student? If so, tell us about your major or course of study.
What is your favorite food?
Do you smoke? If so, what do you smoke and how often?
Do you drink alcohol? If so, how often do you drink and how much?
How often do you get drunk? How do you act when you get drunk?
What are your thoughts on religion?
Are politics important to you? How often do you vote?
Have you had any particularly interesting occupations in your past?
Do you have any pets? If so, please list their name(s) and type(s).
Are you a vegetarian? Do you have any food limitations (e.g. allergies, religious, etc.)?
Have you ever lived with roommates?
What's your favorite TV show?
What's your favorite movie?
What kind of music do you like best?
What magazines do you read?
Do you belong to any affiliations or organizations?
Do you have any body art (piercings, tattoos, etc.)? If so, please describe them.
What's your favorite sport to play? ...to watch?
Section III: Medical & Psychological
Have you been treated for any serious physical or mental illnesses within the last five (5) years? (Circle one)
If you answered "yes" in Question 45, please describe in detail, indicating dates, diagnoses and any ongoing treatments or difficulties.
Please list any allergies you have (medications, food, hay fever, dust, etc.) and your current treatment for them (if any).
Have you ever been diagnosed with, or treated for, alcoholism or any other drug-related addiction? If so, please provide more details, including how long you've been in recovery, if that's the case.
Do you have a temper? How often do you lose your temper? What provokes you?
How do you deal with anger?
How do you deal with someone who intimidates you?
When was the last time you hit, punched, kicked, or threw something in anger? Please provide details.
Section IV: Your Chance to be Creative
List three adjectives that best describe you.
If you could hold any political office, what would it be and why?
What is the accomplishment you are most proud of?
What are you most ashamed of, either now or in your past?
Describe your perfect day.
Who is your hero and why?
List three (3) items you would take with you into the house if allowed and why?
Have you ever been to a nude beach? If so, what was it like?
Finish this sentence: "My life's motto is�
What would you do if this show made you famous?
What types of people would you choose to have living with you in the house?
What types of people would you NOT choose to live with you in the house?
What would irritate you about living in a house with nine to eleven other people?
What do you think would be the most difficult part of living in the house? Explain.
Who is your favorite supermodel? 厃our least favorite? Explain.
Do you have a strategy for winning the contest?
Aside from the modeling contract, what do you hope to gain from being selected as the winner of the show?
Is there anything else you'd like to tell us about yourself and why you think you'd make a great participant for this show and housemate? Try to differentiate yourself and be creative!
Have you ever applied for and/or appeared on any other reality TV shows, dating shows or game shows?
How did you hear about the show?
RELEASE AND WAIVER
Please Print Your Full Name: ____________________________
Please read, fill out, sign, and date the following:
I have listed below, to the best of my knowledge, (i) anyone I know or have known (including myself) who has now, or has been in the past two years, an officer, employee, agent or representative of Viacom Inc., UPN, Ten By Ten Entertainment, Ty Ty Baby Productions, Supermodels, Inc., Pottle Productions, Inc., and/or any of their respective licensees, assignees, or parents, or affiliated or subsidiary companies, and (ii) the titles, jobs, and/or functions such persons have held or occupied:
I hereby acknowledge that: (i) I understand, satisfy, and agree to be bound by, the eligibility requirements for AMERICA'S NEXT TOP MODEL (the "Program"); (ii) I have answered and will answer all questions posed to me honestly and accurately; (iii) If any of the information that I have provided or will provide is found to be false or incomplete, it may be grounds for dismissal from the Program selection process, and/or my being dismissed as a Program participant, if previously selected as a participant; (iv) Even if I meet the eligibility requirements, UPN, Supermodels, Inc., Pottle Productions, Inc., Viacom Inc., and/or any of their respective licensees, assignees, or parents, or affiliated or subsidiary companies (collectively, the "Producers") have no obligation to conduct any initial and/or follow-up interview with me, and/or select me as a participant; (v) Even if I am selected as a participant, the Producers have no obligation to produce the Program and UPN has no obligation to broadcast it, even if it is produced, (vi) In the event that the show is cancelled, or not broadcast for any reason, the Producers have no obligation to award any prize money, (vii) All decisions by the Producers concerning selection of the participants and winners in the Program are final and not subject to challenge or appeal; and (viii) the Producers shall own and shall have no obligation to return or maintain any materials submitted as part of my application whether or not I am or am not selected as a participant.
By submitting this application, I hereby consent to the recording, use and reuse by the Producers, and/or any of their respective licensees, assigns, parents, subsidiaries or affiliated entities and each of the respective employees, agents, officers and directors (collectively "Releasees") of my voice (including, without limitation, my speaking and singing voices), actions, likeness, name, appearance and biographical material (i.e., collectively "Likeness") in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with the Program and the promotion and exploitation (in any form or media) thereof. I agree that Releasees may use all or any part of my Likeness, and may alter or modify it regardless of whether or not I am recognizable. I further agree that Releasees exclusively own any application materials (videos, photos, etc.) that I may have provided in connection with my application for or participation in the Program and any photos and video or recordings of any kind that Producers will make of me in connection with the Program and my application therefor (collectively, the "Materials") and all rights therein and thereto including, without limitation, the right to use the Materials and my Likeness in any and all media now known or hereafter devised worldwide, in perpetuity. Without limiting the foregoing in any way, I further agree that Releasees may use my Likeness and the Materials in connection with any promotion, publicity, marketing or advertisement for the Program or any exploitation of the Program of any kind. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I release Releasees from any and all liability arising out of their use of my Likeness and/or the Materials. I agree not to make any claim against Releasees as a result of the recording or use of my Likeness and/or the Materials (including, without limitation, any claim that such use invades any right of privacy and/or publicity and any claims based on defamation or libel or false light). Without limiting the foregoing in any way, to the degree that the Materials include any musical or literary compositions in which I (partially or wholly) own, or to which I purport to (partially or wholly) own, the copyright or any publishing rights, I hereby grant to the Producers, and have the complete, unfettered right to grant to the Producers, an irrevocable, unlimited, perpetual, worldwide, royalty and payment-free license to use and reproduce such Materials in the Program and in connection with any promotion, publicity, marketing or advertisement for the Program or any exploitation of the Program of any kind, in any and all media now known or which may exist in the future. I understand that the Producers make no representation that such Materials will or will not be used in any way.
This agreement shall be deemed to be entered into in Los Angeles County, California, and shall be governed by and interpreted in accordance with the laws of the State of California applicable to agreements executed and fully carried out within California. Any action, proceeding or litigation concerning this agreement or my appearance or participation in the Program may only be brought in Los Angeles County, California, and I hereby agree that the courts of Los Angeles County, California, shall have exclusive jurisdiction over me and the subject matter of any such proceeding. I agree that any and all disputes or controversies arising under or relating to this agreement or any of its terms, any effort by any party to enforce, interpret, construe, rescind, terminate or annul this agreement, or any provision thereof, and any and all disputes or controversies arising under or relating to my possible appearance or participation in the Program, shall be resolved by binding arbitration in accordance with the following procedure: either (i) the Producers and I shall mutually select an arbitrator, who shall be a retired judge of a state or federal court or (ii) if we cannot agree on such arbitrator, the Producers and I shall each select one arbitrator, who shall both be retired judges of state or federal courts and those two arbitrators shall then select a third arbitrator, who shall also be a retired judge of a state or federal court. All arbitration proceedings shall be conducted in accordance with the Commercial Arbitration Rules of the American Arbitration Association, through its Los Angeles, California office. I agree that the arbitrator's ruling, or arbitrators' ruling, as applicable, in the arbitration shall be final and binding and not subject to appeal or challenge. I further agree that the arbitration proceedings, testimony, discovery and documents filed in the course of such proceedings, including the fact that the arbitration is being conducted, will be treated as confidential and will not be disclosed to any third party to such proceedings, except the arbitrator(s) and their staff, the parties' attorneys and their staff, and any experts retained by the parties; provided that such arbitrator(s) and their staff, the parties' attorneys and their staff, and any experts retained by the parties each first agree in writing that such information and documents will be treated by them as confidential, consistent with this provision. The parties hereto agree that, notwithstanding the provisions of this paragraph, Producer shall have a right to injunctive or other equitable relief as provided for in California Code of Civil Procedure 1281.8 or other relevant laws. Without limiting the foregoing, any provision of this agreement that is invalid, illegal, or unenforceable in any jurisdiction will, as to that jurisdiction, be ineffective only to the extent of such invalidity, illegality or unenforceability, without affecting in any way the remaining provisions hereof in such jurisdiction or rendering that or any other provision of this agreement invalid, illegal or unenforceable in any other jurisdiction. This agreement expresses the entire understanding between me and the Producers and replaces any and all former and contemporaneous agreements, understandings or representations between me and the Producers. Any laws that require or suggest that the interpretation of a document or agreement, or the resolution of any ambiguities contained therein, should be resolved against the drafter of the document or agreement, are hereby waived. No modification, alteration or amendment of this agreement will be valid or binding unless in writing and signed by both me and the Producers. No waiver by the Producers of any term or condition of this agreement will be construed as a waiver by the Producers of any other term or condition; nor will any waiver by the Producers of any default under this agreement be construed as a waiver by the Producers of any other default. It is further understood and agreed that no failure or delay in exercising any right, power or privilege hereunder shall operate as a waiver thereof, nor shall any single or partial exercise thereof preclude any other or further exercise thereof or the exercise of any right, power or privilege hereunder. The Producers may freely assign, in whole or in part, any of their rights or obligations under this agreement. I may not assign my rights and obligations under this agreement.
I have signed this release on the _________ day of _____________, 200_
Name (Please print or type): _________________________